Healthcare Provider Details

I. General information

NPI: 1114573243
Provider Name (Legal Business Name): OLIVIA MARIE DELISA MSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/14/2019
Last Update Date: 10/14/2026
Certification Date: 10/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14202 20TH AVE
FLUSHING NY
11351-3000
US

IV. Provider business mailing address

40 WASHINGTON AVE
EAST ISLIP NY
11730-1132
US

V. Phone/Fax

Practice location:
  • Phone: 718-559-0555
  • Fax:
Mailing address:
  • Phone: 516-513-9046
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number095847
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: